| NPI | 1407149883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R2384) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301097883) |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2020-08-04 |